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In this issue of the American Journal of Kidney Diseases, Ghaffari1 describes a program for patients with chronic kidney disease (CKD) first seen within 2 weeks of the anticipated need for dialysis therapy. Such patients are often unable to consider their options for renal replacement therapy and begin incenter hemodialysis with a central venous catheter. The program instituted by Ghaffari offered decision support for late-referred patients by administering a questionnaire to ascertain the presence of barriers for the patient to perform peritoneal dialysis. Based on the responses, the physician made a recommendation about the dialysis modality appropriate for the patient. If the patient chose peritoneal dialysis, the catheter was placed percutaneously by an interventional radiologist and peritoneal dialysis therapy was begun shortly after placement of the catheter. Using this approach, Ghaffari was able to expand access of late-referred patients to peritoneal

dialysis. Thus, not only were the patients able to choose their dialysis modality, it obviated the use of a central venous catheter.